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Prospective Risk Adjustment Advisor
2 months ago
Centene Corporation is seeking a highly skilled Risk Adjustment Market Strategist to join our team. As a key member of our Risk Adjustment Prospective team, you will play a critical role in developing and executing strategies to improve risk adjustment performance for our assigned markets.
Key Responsibilities- Develop and execute risk adjustment prospective strategies for assigned markets, including building strong working relationships and maintaining high market satisfaction.
- Collaborate with market staff and leadership to enhance quality-monitoring tools, implement process improvements, and develop training plans for market staff aimed at improving Partnership for Quality participation/completion.
- Develop and employ process-monitoring tools to identify root cause and provide timely reporting on productivity, audit results, and process improvement opportunities.
- Own and manage the relationship and performance of assigned markets as it relates to risk adjustment.
- Perform data analysis and develop specific actions to manage market performance.
- Develop and implement Partnership for Quality and In-home Assessments workflows and policies & procedures.
- Lead and deliver training programs and updates internal and external training documents and other materials.
- Proactively monitor appropriate metrics to improve both quality and drive efficiency.
- Direct involvement in building collaborative relationships with other departments to resolve quality issues and barriers.
- Drive improvement of market performance by analyzing, interpreting, and communicating risk and quality metrics.
- Establish and lead cross-functional communication and collaboration with internal departments to support market performance and resolve barriers and challenges.
- Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
- Responsible for understanding Risk Adjustment, HEDIS, and STARS measures and partner the Quality team to drive improved provider performance.
- Special projects as assigned or directed.
- 3-5 years of experience in Network Management/Network Development, Provider Relations, Risk Adjustment, Risk, and/or Value-Based Contracting.
- 3+ years of experience in Healthcare or Managed Care.
- Preferred 1+ year of experience in Leading or supervising others.
- Preferred 3+ years of experience in Medicare/Medicaid Risk Adjustment.
